Cervical spine imaging in trauma patients: a simple scheme of rationalising arm traction using zonal divisions of the vertebral bodies.

OBJECTIVE: To evaluate the effectiveness of arm traction for cervical spine imaging in trauma patients and devise a scheme to predict the probability of visualising the C7/T1 level in trauma patients. METHODS: 98 trauma patients were studied. Each vertebral body was divided into three equal horizontal zones, the disc space between vertebral bodies being equivalent to one zone. The fifth cervical vertebra was used as the starting level (zone 1). Zones obtained pre and post arm traction on the lateral cervical spine radiographs were recorded. Results were analysed to show the probability of imaging the lower cervical spine, including the cervico-thoracic junction. RESULTS: If the initial film showed less than zone 10 (mid-C7 vertebra), the probability of showing zone 13 (upper body of T1) with arm traction was only 7.7%, that is, one success in every 13 pulls; or conversely, 12 failures in every 13 pulls. CONCLUSIONS: Unless an initial cervical spine radiograph includes the upper one third of the body of the C7 vertebra, the probability of attaining the C7/T1 level with arm traction is < 15%. It is suggested that all initial radiographs of the lateral cervical spine in major trauma patients be done with arm traction, and where the upper one third of the body of C7 vertebra is not seen, then computerised tomography, swimmer's, or oblique views be considered.

Disturbance of plasma thyroid hormone levels after experimental liver transplantation. Is there an association with primary graft nonfunction?

It has been suggested recently that preoperative plasma thyroid hormone levels may be used to predict the success of liver transplantation in prospective recipients and also perhaps that postoperative levels may be used to identify rejection. In the present study of unimmunosuppressed porcine recipients of liver allografts, two groups of animals were identified--those that died within five days postoperatively and the other group that were longer survivors. On the first postoperative day plasma levels of total and free T4 and total and free T3 declined and of total rT3 increased. In survivors these levels returned towards normal within three days, while they persisted in nonsurvivors. As there was no obvious cause of graft failure in nonsurvivors, the state might be considered to represent primary graft nonfunction in pigs, and the changes in plasma thyroid hormone levels may be predictive of this condition; a study in patients may confirm this.

Ice skating injuries: can they be reduced or prevented?

The opening of an ice rink resulted in 469 attendances at the local Accident and Emergency department over the first year. One hundred and eight had a significant injury. Thirty-seven patients were admitted. Thirty-three required an operation under general anaesthesia. Thirty had consumed alcohol at the rink's bar. Nine of these had a fracture. The number of skates attending the Accident and Emergency department per 1000 visits to the rink declined over the study period. Injuries could be reduced if protective clothing was worn. Alcohol should not be sold at the rink. First aid although effective could be improved.

The aminopyrine breath test predicts the outcome of hepatic transplantation in pigs.

The aminopyrine breath test has been performed on Day 1 and Day 7 in pigs following experimental liver allografting. The results show that at 24 hr after surgery there was a significant reduction in liver function in all animals as measured by the elimination rate constant of 14CO2 in the breath. This was very profound in the group that died within 5 days (0.09 +/- 0.01 hr-1) and was significantly different from the group that survived (0.16 +/- 0.01 hr-1). There appears to be a critical value of the elimination rate constant (= 0.12 hr-1) which predicts death within 5 days. These results would justify a trial of the aminopyrine breath test in patients after liver transplantation.

Renal trauma and the intravenous urogram.

A retrospective analysis of all patients with blunt abdominal trauma associated with haematuria admitted to one hospital (Royal United, Bath) in a 10-year period was conducted to establish the contribution of the intravenous urogram (IVU) in their management. Eighty-one case records were analysed. Of 35 IVUs performed in patients with microscopic (reagentstrip positive) haematuria, only one was abnormal. In contrast, 27 IVUs performed in patients with macroscopic (naked eye) haematuria revealed 17 major injuries and 5 previously unrecognized congenital abnormalities. It is concluded that an IVU is an unnecessary and non-contributory investigation in patients with microscopic haematuria and guidelines are suggested for the role of IVU in patients with blunt abdominal trauma associated with haematuria.

Takayasu's arteritis: a pathogenetic role for cytotoxic T lymphocytes?

Takayasu's arteritis is an inflammatory panarteritis of unknown aetiology affecting large elastic arteries. We examined a segment of abnormal common carotid artery removed at by-pass surgery from a 23-year-old man with typical angiographic features of Takayasu's arteritis. Using monoclonal antibodies we were able to demonstrate marked infiltration of the arterial wall with OKT8 positive lymphocytes (suppressor/cytotoxic cells) but not with OKT4 positive lymphocytes (helper cells). Studies of circulating lymphocytes showed increased numbers of "activated" cells and increased in vitro cytotoxicity against cultured human umbilical cord endothelial cells, compared to normal lymphocytes. Cellular immunological mechanisms may play an important role in the pathogenesis of Takayasu's arteritis, possibly through the direct action of cytotoxic T cells on large elastic arteries.